0071643192.pdf

TECHNIQUE

■ An X-ray may be useful to confirm the presence of a FB and to define its

size and position.

■ Patient assumes knee-chest or lateral decubitus position.

■ IV sedation and/or perianal block may be required.

■ Perianal block: Local infiltration is administered circumferentially

around the anus in the submucosal tissue.

■ Perform direct rectal examination (DRE) to gauge position/orientation

of FB.

■ Application of suprapubic pressure while patient performs a valsalva maneuver

may deliver FB.

■ If unsuccessful, an anoscope, rigid sigmoidoscope, vaginal speculum, or

retractor can be inserted into the anus to visualize FB clearly. An instru-

ment can then be used to secure and remove the FB along with the

anoscope as a single unit.

■ If a vacuum is created between FB and mucosa, it must be released by dis-

tending the rectal wall around the FB with air. This can be done using a

sigmoidoscope or a Foley catheter passed beyond the FB and balloon

inflated.

COMPLICATIONS

■ Failure to remove FB

■ Mild mucosal edema and rectal bleeding are common.

■ Perforation or deep mucosal tearrequire hospitalization.

■ Cracking or shattering of glass FB may require surgical exploration and

retrieval.

INTERPRETATION OFRESULTS

■ Removal of intact FB under direct visualization without abdominal pain,

fever, or severe bleeding indicates successful removal.

Diagnostic Peritoneal Lavage

INDICATIONS

■ To determine or exclude the presence of intraperitoneal hemorrhage in

the hemodynamically unstable blunt or penetrating trauma patient

■ Useful when ultrasound is unavailable, is technically difficult, or results are

indeterminate, especially when the patient is hemodynamically unstable

■ May be useful in evaluating patient with CT demonstrating free fluid

without evidence of solid organ damage

CONTRAINDICATIONS

■ Relative:

■ Prior abdominal surgery or infections, obesity, coagulopathy, second or

third trimester pregnancy

TECHNIQUE

■ Stomach and bladder should be decompressed. Patient is supine. Sedation

and analgesia provided if appropriate. Use sterile technique.

■ In the open technique, a 4- to 6-cm incision is made infraumbilically in

the midline to reach the linea alba. A 2- to 3-mm opening is made in the

linea alba in the semiopen technique and extended in the fully open

PROCEDURES AND SKILLS

Consider DPL for blunt trauma

victims with free fluid on

ultrasound and obvious signs

of liver disease and suspected

ascites. A DPL with no blood

may spare the patient a

nontherapeutic exploratory

laparotomy.